A study recently came to light that suggests that aerobic fitness (aka exercise) can protect the brain from atrophy and lesions in people with multiple sclerosis. Put simply, the study showed that:
- People with MS who worked out more performed better on cognitive tests. Cognitive dysfunction is a very common symptom of people with MS.
- Physically fit people with MS had fewer lesions and less brain atrophy than those people with MS who were less fit.
The hypothesis is that exercise increases production of nerve growth factors, which in turn, have some role in maintaining the myelin and neurons in people with MS.
Frankly, I am skeptical about drawing any conclusions to support this hypothesis from this study and I'll tell you why (let me mention that I have not been able to read the original article in Brain Research, so maybe some of my questions are answered there).
Here are some of my concerns or questions about this study:
"Fitness" was partially determined by V02 max, a measure of lung capacity. Lung capacity can be very diminished in people with MS, although even the people with reduced lung capacity are often unaware that this is happening, as it may just manifest as getting tired easily or a little shortness of breath now and then. (Read more here: Respiratory Problems in People with Multiple Sclerosis)
I have not seen it mentioned whether all of the people with MS in the study were somewhat similar as far as physical abilities (or if this was adjusted for statistically, which is a little difficult as there were only 21 participants with MS), such as that measured by Expanded Disability Status Score (EDSS). I would hope so, as it goes to reason that someone with minimal disability would probably be more able and likely to engage in aerobic exercise than someone who found it more difficult to get around and would have to be more creative with their exercising approaches. EDSS is not perfect, either, as it focuses on walking as a measure, ignoring other symptoms like fatigue or depression, which could also be a factor on whether someone engaged in an exercise program (although various studies show that exercise might be helpful in combating these symptoms).
Following on the last point, the study says that there was less destruction of brain matter in the "fitter" people and this correlated with higher cognitive abilities. It has long been shown that cognitive dysfunction is linked to brain atrophy (destruction of neurons). I don't know that brain atrophy can be slowed by "fitness" - in my opinion, it is more likely that the people considered more "fit" might be that way because of their brain (less damage correlating with better lung function and less fatigue), rather than their fitness being the reason for their less-damaged brain.
Bottom line: Please do not take my skepticism about the results of this study to mean that I don't wholeheartedly support exercise for people with MS. I think exercise is crucial to keep us going and I have recently renewed my commitment to a regular exercise plan to see if I can feel a little better and to get in shape. I am very certain that for some people exercise keeps some of the physical symptoms of MS from affecting them as much as they could. However, let me repeat - I would be hesitant to say that this study shows that we can significantly slow damage to our brains from MS through exercise, based on the information that I have (it seems like that would require a huge prospective study to be conclusive). This is one of those cases where I would love to be proven wrong, however.
Source:
Whelp Julie,
I certainly agree exercise stimulates the mind and body, however, according to a recent article I read The Stranger Within or something (I think it was from Rocky Mountain MS newsletter-but ain’t sure since I have cognitve issues) Depression IS an MS symtom (I certainly believe it’s one one mine). Depression lends to a sluggish body and mind, and makes it OH so difficult to motive oneself to exercise, let alone THINK. ANd let’s not forget the central nervous system depressant meds we take to cope with spasticity and pain which contribute greatly to stupidity, hence, like you Julie, I’m very skeptical of that cognitive/exercise test results.
If only I could get my foggy brain and phat butt off the couch I’d try putting that theory to the test, because of all the things I MISS about my pre-MS self, I miss my mind the most!!!
I was diagnosed with MS in June 2008. I was 265lbs and in horrible physical shape. I was suffering from fatigue, depression, cognitive issues (mainly frequently switching words) pain from MS, spinal seizures, foot drop, MS Hug, you name it I had it or if not I would have it after you said it
.
I started Rebif 1 month later and this added to my fatigue level. But then a wonderful nurse that showed me how to do my injections told me that if I lost the weight that perhaps it would improve my symptoms. Duh!!!
I started a workout routine 5-6 days a week. These started out easy because I would have many MS “issues” as I exercised. But eventually they would lesson. I upped the intensity GREATLY in my workouts. I now do 45 – 60 minutes of Interval training 3 days a week and weight training twice a week. I still get some MS issues during the workout but I ignore or work around them the best I can and they go away once I shower afterwards.
I lost 85 lbs and gained much more muscle. IT WAS NOT EASY, but I sincerely believe it is why I am so much better today than I was almost two years ago.
I think better, faster, don’t switch my words any more, my footdrop disappeared, spinal seizures have disappeared, I quit the Rebif, and I am even finding I can JOG and RUN again. I never would have thought this was even possible 2 years ago.
On days I do NOT do my workouts, I notice fatigue hits me much more often and earlier in the days. It is very repeatable. I can only assume the endorphins released during the workouts hold off the fatigue until much later in the day.
Bottom line for me is I would tend to believe the study given my own personal experience. I believe that exercise has not only made me feel better, but it has affected my MS.
Take care and Stay Healthy!
Jeff
When I was first diagnosed with MS 16 years ago I searched out to find everything and anything to read to learn about this disease named Multiple Sclerosis. At that time most literature written discouraged people with MS to exercise and over exert themselves. Frankly, I quickly ignored this information I was reading and increased my exercise regimen. For the past 16 years I religiously have done each and EVERY day a two hour cardio workout and a 90 minute weight workout every other day. Fortunately, although I still have many lesions on my brain due to MS, any outward symptoms associated with the disease has been minimal over these past 16 years. Bottom line, I am a FIRM believer in exercise for EVERYONE, but especially for many people living with MS.
Bill, I am wondering if you could mention what you do for your cardio routine and what kind of weight work out you do. Are you on any MS drug? Thank you for your post!
Teresa,
I have been taking either Avonex, Rebif or Copaxone for the first 18 years since being diagnosed with MS. Two years ago I decided these drugs were useless for me and I stopped taking any and all MS drugs. Had an MRI one year after making this decision to halt my daily stick of Copaxone and it showed no further progression of the disease.
Regarding exercise, I usually do a one hour “spin” class each day six to seven days a week. I also run seven miles/day seven days a week. I do a 90 minute multiple weight program three days a week. I also walk with my wife typically one hour a night about five nights a week. May seem obsessive, but I do believe it has helped my fight against MS AND it is keeping me in shape! Been doing this routine for the past 20 plus years.
Recent studies have shown that exercise for older people helps slow cognitive decline…why wouldn’t that be also true for people with MS?
This is a very interesting topic. Yesterday, I was reading an article reprinted from a LA Times Article called “When Those with Chronic Illness Exercise More, They Worry Less”. This 22/22/10 article reported on a study reported in the Archives of Internal Medicine on on how exercise influences anxiety. It said that “Exercise helped people no matter what kind of health problem they had: cancer, depression, heart disease, fibromyalgia. Multiple sclerosis was the only condition in which exercise did not appear to have a significant effect.” I think that is just ridiculous. All over the world, people with MS are being helped by exercising. I cannot believe that they even reported that fact. For those who have MS and do not like to exercise, if they read this, they might just decide not to exercise at all. How ridiculous!!!
um…I should add to my previous comment I am usually able to force myself to exercise 20 to 30 minutes, average 4 to 5 days a week. I swim laps. In spite of feet problems I Used to do treadmill 30 to 40 minutes a day and was feeling great for two years. Got out ot the routine after carpol tunnel surgery on first one wrist than the other. I Wasn’t supposed to sweat or get the stitches wet for 3 weeks. One side healed and immediatly I got the other wrist done.
I’ve slowly gone downhill since. The last year and half I’ve woken with a frozen shoulder 4 times (two times each shoulder at different times). It’s extremely painful and takes about 6 weeks to recover enough to swim; by then I’m out of routine and have to try to start my routine all over again. Now I’m at the point of “WHY TRY when I keep getting the rug pulled out from under me?”
My body doesn’t want to get out of bed, so I take adderall right after waking to help jump start my day. I’ try because I HATE the idea of being non-productive and a lump in bed. It is sooo difficult to keep trying, but I know the end result is I feel better about myself. Exercise gets juices flowing, or my circulation flowing better; gets my endorphins up (I do suffer from major depression despite taking an anti-d).
A month after quitting my ego boastings job as a newspaper editor, writer and photographer 4 years ago because of MS (and losing my ego and identity in the process) I won a treadmill at a local Health Fair. At the time I was having difficulty walking because of fatigue and feet problems so I didn’t think I’d actually use the tread mill. An acquataince suggested I put it in front of the TV. At the time I didn’t watch much TV (I was a TV snob who thought it a waste of time so I was like, “yeah, right…”).
But I followed her advice. I started walking the treadmill while watching Oprah. At the time Oprah was losing weight and saying things about reinventing herself. So I joked to friends I was reinventing myself with Oprah – and I was!
I was feeling good and strong (as well as I could with MS), not having to take muscle relaxers or major pain meds (I was in pain but chose at that time to live with the pain). I also had no new lesions (I have numerous in my brain, stem and spine). In the two years I’ve stopped the treadmill I’ve gained almost 20 pounds…I’ve also felt the MS beast within grab a stronger hold and progress.
So yeah, I do believe exercise is extremely helpful to our MS mind and body, as well as for healthy people.
But It IS so difficult to motivate oneself when fighting the beast within….
Julie, I am disappointed in your comments. And, I believe some of the responses show how negatively influential your comments are for people that have MS.
I may never return to this site.
So the question is: Does exercise help MS patients? Let’s turn that around: Does exercise hurt MS patients? If the jury is out on whether it is specifically helping MS patients, we know from numerous studies it helps our heart, our blood flow, weigh loss, our mind set etc., than why not do it. If nothing is saying it hurts, and it helps other parts of our body, there is no excuse to not put exercise in your lifestyle. Problem is people who don’t exercise or are familiar with exercise think they have to lift weights for an hour 3 days a week, walk 5 miles a day or do a aerobics class. You don’t!! Just walk around the block, or take the stairs, or park farther from the store entry. If you need assistance, go with someone for balance if necessary. My point is, just do something!!
Julie, I appreciate your comments. I am so tired of hearing that exercise is the “end all be all”. I have exercised for the past two years (weights & aerobics)but never show any improvement. I quit the aerobics but continue with weights to support my husband. There have been other studies that show that exercise does not benefit everyone.
I was about 40 pounds overweight with relapsing remitting ms. I started exercising daily for 40-50 minutes. I feel so much better and it is easier to move. It is so important to keep moving with MS. It doesn’t matter what you do, just keep fighting. I’ve had MS since 2004, however it does not have me!
RK, it’s funny – I hesitated before posting my concerns for the very reason that you mention – I do NOT in any way want to discourage anyone with MS from exercising. Like I mentioned, I have restarted my own exercise program with really great results – I have gained at least a couple of hours each day of functionality as the exercise keeps my fatigue at bay until later in the day.
My motivation behind posting my comments was mainly to look a little deeper into the claims around the results of the study. Again, I don’t know if exercise protects us from brain damage – this could get slippery if people assume that people who experience progression simply weren’t “trying hard enough” and could have prevented this by exercising. I never want to hear that.
Again, for most people who can do it, exercise is great – let’s not forget, along with our MS, we are traveling the same road of aging and lifestyle factors as everyone else.
RK, again, I appreciate you pointing out that my comments could negatively influence someone on the verge of starting an exercise program – I certainly would not want to do that. Good luck to you.
-omega 3 helps your brain recover faster
-black seed oil im speechless
the above are very good for you!
i has ms since 2008 mashalla im improving i
walk regularly
oh yh important the cause of ms is found!!!!!
read article –
http://www.theglobeandmail.com/news/national/researchers-labour-of-love-leads-to-ms-breakthrough/article1372414/
Despite having cognitive disfunction, everyone with MS has the capacity to think and make decisions for themselves. I do not really believe that comments from Julie are going to completely change anyone’s opinion. They are just her personal comments, this being her blog and all, and she did make a point of directly stating: “Please do not take my skepticism about the results of this study to mean that I don’t wholeheartedly support exercise for people with MS. I think exercise is crucial to keep us going and I have recently renewed my commitment to a regular exercise plan to see if I can feel a little better and to get in shape.” Having to deal with a chronic illness every day can make us all angry sometimes, but let’s try not to take it out on each other.
I think that you are right that this study was not enough to show much correlation.
I was an *extremely* athletic kid. I used to be the “secret weapon” on my soccer team because of how much stamina and especially speed that I had. I would go to karate right after my soccer practice. I basically was crazy athletic from 6 years of age to 19. Then I stopped. I stopped because I was dead tired, probably due to M.S.
If the theory is true that exercise would prevent or even help cure M.S., then I really should never have “come down” with it. It *stopped* me from exercising.
I was a bit surprised to see RK’s comment and wondering if RK’s mind was in a bit of MS cognitive defunction when reading her article. I did not get the idea Julie was negative toward exercising and it’s benefits at all. I felt Julie just questioning the validity of such a study, its hypothesis and accurateness regarding the correlation between exercise spuring production of nerve growth and the role it plays in possibly preventing new MS lesions.
Hey RK, let’s say we team up and put our negative energy toward attacking the sap who decided a good motto for us with MS is, “I may have MS but MS doesn’t have ME.” WHAT a LOAD of CRAP that line is! … am I right??! Hello…. I have MS and it DOes have me — it effects everything I do, say and think!
Me thinks MS’s got me a bit manic today – commenting three times in this one blog! Help, I’m falling and can’t get up –
PS… IF the study could prove exercise slows the rapid spiral downhill of Progessive MS THEN I’d take the study seriously.
Until then I’m gonna to try to keep exercising because overall I do and feel better.
As a veterinarian and scientist I wholeheartedly agree with Julie’s very healthy skepticism. After being kicked badly by a horse patient and the resultant spinal cord injury my exercise became limited. I live near Lake Tahoe and physical activity is our family life. I was ON MY TREADMILL when I had my first MS attack. I weighed 145 lbs and was fit. Now I am closer to 185 and have not exercised much since that first attack. For whatever reasons I just cannot exercise much. Hurts, physically unable most of the time and just too tired. I also still have to work full time as a vet which is very demanding physically and mentally. My spasticity keeps my legs buffed but that is it. One of the early signs of MS was when swimming suddenly I had to “tell” my legs to kick with each stroke. No more swimming. I agree that exercise is good for so many reasons and we should all do what we can but do not add to your anxiety and depression if you cannot!! I applaud you Julie for remaining scientific in your assessment of articles. You help us all much more with your science background and it is appreciated. I never for a second thought you were suggesting not exercising. I saw a healthy dose of scientific skepticism. Please keep it up for all of us and good luck with your exercise. To the one who does 3.5 hours a day, Wow. I don’t have that much free time in an entire day total. Good for all of you who get in shape but do not blame us who cannot for our MS and its progression.
Brooks
Hi Julie,
Thanks for the article. Although I don’t have the “MS Hug”, I just wanted you to know that I have double a scoliosis (42 LC), as well as a MV prolapse. On top of course I have MS and psoriais…etc. I also had an episode of what looked like Crohn’s (a few months back). But I still think it could be worse…or might get worse. The hardest part is when people don’t think we are in pain from MS since we “look” normal. Keep up the good work and thanks again for writing.
Interesting. I have been in good shape physically my whole life, always exercising and weight training. I cannot say I have always done it daily and like many have had down times but not so much to classify me as not fit. I pray for the day researchers truly figure out why this disease occurs so we can actually be closer to answers, better treatments and a cure.
What came to be my first MS attack in 98, MS Dx in 08. In between then and now, big into Judo and Jiujitsu.. both rough martial arts that require live training and wrestling resisting opponents and are heavy on cardio and core strength and i believe that the constant exercise during those 10 years that i didn’t have a diagnosis is what kept me from getting worse.
Once i got diagnosed and after the whole shock and depression that comes with such a diagnosis, i got back into those two, and have trained harder than i did before. Now between that, Copaxone, and a better diet, i’m pretty sure i have my MS under control since i have actually gotten stronger and in better shape than i have been in my whole life.
Now i know everyone has a different course of MS, and that yes, for now i am “lucky” that my symptoms aren’t as bad as some of you out there, but i can tell you with certainty, that sitting around not doing anything at all with MS as our reason is definitely detrimental to our condition.
I HAVE TRIED RELATE TO THE HUMAN RACE IN GENERAL. IT IS NOT ANYTHING ABOUT PEOPLE WITH MS THAT MAKES ISOLATES ME FROM THEM.
SO THIS IS THE PERSONALITY OUT COME. RESEARCHERS ARE FINDING SLUM CELL RESEARCH NOT ONLY BENEFITS THE PEOPLE WHO NEED SLUM CELLS BUT ALSO FEEL THAT SLUM CELL STOCKS ARE A GOOD INVESTMENT. THE COURTS FEEL THAT THE DRUG LORDS ARE THE REAL PROBLEM NOT THE SLUM LORDS.
The skepicism about the cause-effect conclusion is well reasoned. I was diagnosed 11 years ago and, like other readers, laid off a lot of physical exertion. That was a mistake. There are no really good reasons not to exercise and get and stay fit. But I don’t think “fitness” has a direct effect on MS lesions.